I 

118TH CONGRESS 

2D SESSION H. R. 8987 

To amend title XXVII of the Public Health Service Act, the Employee 

Retirement Income Security Act of 1974, and the Internal Revenue 

Code of 1986 to ensure cost sharing for a drug does not exceed the 

nationwide average of consumer purchase prices for such drug. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 10, 2024 

Ms. PORTER (for herself, Ms. DELAURO, Mr. GRIJALVA, Mr. COHEN, and Ms. 

OMAR) introduced the following bill; which was referred to the Committee 

on Energy and Commerce, and in addition to the Committees on Ways 

and Means, and Education and the Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such 

provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend title XXVII of the Public Health Service Act, 

the Employee Retirement Income Security Act of 1974, 

and the Internal Revenue Code of 1986 to ensure cost 

sharing for a drug does not exceed the nationwide average of consumer purchase prices for such drug. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Lowest Price for Pa5 tients Act of 2024’’. 


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1 SEC. 2. ENSURING COST SHARING FOR A DRUG DOES NOT 

2 EXCEED THE NATIONWIDE AVERAGE OF CON3 SUMER PURCHASE PRICES FOR SUCH DRUG. 

4 (a) PHSA.—Subpart II of part A of title XXVII of 

5 the Public Health Service Act (42 U.S.C. 300gg–11 et 

6 seq.) is amended by adding at the end the following new 

7 section: 

8 ‘‘SEC. 2730. LIMITATION ON COST SHARING FOR DRUGS. 

9 ‘‘(a) IN GENERAL.—For plan years beginning on or 

10 after the date of the enactment of this section, a group 

11 health plan, and a health insurance issuer offering group 

12 or individual health insurance coverage, may not impose 

13 cost sharing (including deductibles, coinsurance, and co14 payments) with respect to a covered outpatient drug for 

15 which benefits are available under such plan or coverage 

16 dispensed by an in-network pharmacy in an amount that 

17 exceeds the nationwide average of consumer purchase 

18 prices for such drug for the 1-year period ending on the 

19 first day of such plan year (as determined using informa20 tion from the survey described in section 1927(f)(1)(A)(i) 

21 of the Social Security Act). 

22 ‘‘(b) CLARIFICATION ON APPLICATION TO PHARMACY

23 BENEFIT MANAGERS.—A group health plan, and a health 

24 insurance issuer offering group or individual health insur25 ance coverage, shall ensure that any pharmacy benefit 

26 manager providing services under the plan or coverage 


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1 complies with subsection (a) in the same manner as such 

2 subsection applies with respect to such plan or issuer. 

3 ‘‘(c) DEFINITIONS.—In this section: 

4 ‘‘(1) COVERED OUTPATIENT DRUG.—The term 

5 ‘covered outpatient drug’ has the meaning given 

6 such term in section 1927(k) of the Social Security 

7 Act. 

8 ‘‘(2) IN-NETWORK PHARMACY.—The term ‘in9 network pharmacy’ means, with respect to a group 

10 health plan or group or individual health insurance 

11 coverage and a drug, a pharmacy with a contractual 

12 relationship in effect for dispensing such drug under 

13 such plan or coverage.’’. 

14 (b) ERISA.— 

15 (1) IN GENERAL.—Subpart B of part 7 of sub16 title B of title I of the Employee Retirement Income 

17 Security Act of 1974 (29 U.S.C. 1185 et seq.) is 

18 amended by adding at the end the following new sec19 tion: 

20 ‘‘SEC. 726. LIMITATION ON COST SHARING FOR DRUGS. 

21 ‘‘(a) IN GENERAL.—For plan years beginning on or 

22 after the date of the enactment of this section, a group 

23 health plan, and a health insurance issuer offering group 

24 coverage, may not impose cost sharing (including 

25 deductibles, coinsurance, and copayments) with respect to 


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1 a covered outpatient drug for which benefits are available 

2 under such plan or coverage dispensed by an in-network 

3 pharmacy in an amount that exceeds the nationwide aver4 age of consumer purchase prices for such drug for the 1- 

5 year period ending on the first day of such plan year (as 

6 determined using information from the survey described 

7 in section 1927(f)(1)(A)(i) of the Social Security Act). 

8 ‘‘(b) CLARIFICATION ON APPLICATION TO PHARMACY

9 BENEFIT MANAGERS.—A group health plan, and a health 

10 insurance issuer offering group health insurance coverage, 

11 shall ensure that any pharmacy benefit manager providing 

12 services under the plan or coverage complies with sub13 section (a) in the same manner as such subsection applies 

14 with respect to such plan or issuer. 

15 ‘‘(c) DEFINITIONS.—In this section: 

16 ‘‘(1) COVERED OUTPATIENT DRUG.—The term 

17 ‘covered outpatient drug’ has the meaning given 

18 such term in section 1927(k) of the Social Security 

19 Act. 

20 ‘‘(2) IN-NETWORK PHARMACY.—The term ‘in21 network pharmacy’ means, with respect to a group 

22 health plan or group health insurance coverage and 

23 a drug, a pharmacy with a contractual relationship 

24 in effect for dispensing such drug under such plan 

25 or coverage.’’. 


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•HR 8987 IH

1 (2) CLERICAL AMENDMENT.—The table of con2 tents in section 1 of such Act is amended by insert3 ing after the item relating to section 715 the fol4 lowing new item: 

‘‘Sec. 726. Limitation on cost sharing for drugs.’’. 

5 (c) IRC.— 

6 (1) IN GENERAL.—Subchapter B of chapter 

7 100 of the Internal Revenue Code of 1986 is amend8 ed by adding at the end the following new section: 

9 ‘‘SEC. 9826. LIMITATION ON COST SHARING FOR DRUGS. 

10 ‘‘(a) IN GENERAL.—For plan years beginning on or 

11 after the date of the enactment of this section, a group 

12 health plan may not impose cost sharing (including 

13 deductibles, coinsurance, and copayments) with respect to 

14 a covered outpatient drug for which benefits are available 

15 under such plan dispensed by an in-network pharmacy in 

16 an amount that exceeds the nationwide average of con17 sumer purchase prices for such drug for the 1-year period 

18 ending on the first day of such plan year (as determined 

19 using information from the survey described in section 

20 1927(f)(1)(A)(i) of the Social Security Act). 

21 ‘‘(b) CLARIFICATION ON APPLICATION TO PHARMACY

22 BENEFIT MANAGERS.—A group health plan shall ensure 

23 that any pharmacy benefit manager providing services 

24 under the plan complies with subsection (a) in the same 


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1 manner as such subsection applies with respect to such 

2 plan. 

3 ‘‘(c) DEFINITIONS.—In this section: 

4 ‘‘(1) COVERED OUTPATIENT DRUG.—The term 

5 ‘covered outpatient drug’ has the meaning given 

6 such term in section 1927(k) of the Social Security 

7 Act. 

8 ‘‘(2) IN-NETWORK PHARMACY.—The term ‘in9 network pharmacy’ means, with respect to a group 

10 health plan and a drug, a pharmacy with a contrac11 tual relationship in effect for dispensing such drug 

12 under such plan.’’. 

13 (2) CLERICAL AMENDMENT.—The table of sec14 tions for such subchapter is amended by adding at 

15 the end the following new item: 

‘‘Sec. 9826. Limitation on cost sharing for drugs.’’. 

Æ 


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